I stopped answering these questions because thinking about them made me upset so I took a long break. Question 1 was answered April 8, 2012 and can be found here.
I encourage you to share your answers in the comment box or just think about them in your head
This is all one question I’m just breaking it up so it’s less confusing (I was having difficulty following).
According to the DSM, a mental disorder is an illness only if it “causes you clinically significant impairment or distress.” (170) This means, the author says, that “for the most part, it’s up to you to decide if you are impaired or distressed; a mental illness is an illness only if it is a problem for you.” (170) How does this definition of disease compare to yours?
Are you concerned about subjectivity in make medical decisions?
Are you concerned that doctors must make their diagnosis based on what patients tell them, rather than on what they can determine from medical tests?
This definition of disease (it is one if it causes you personal significant impairments) doesn’t sit well with me. I like to think that a disease should be one no matter what. Just because someone with cancer lives their life to the fullest and doesn’t let it stop them doesn’t make the cancer less of an issue. They still have cancer, they still have a disease. It seems strange to me that mental health would be the only medical issue that is in the eye of the beholder so to speak. That decreases its validity to me.
I am very concerned about the subjectivity found in mental health. I like to think that medicine is based on hard facts, that my doctors have a high level of knowledge indicative of their level of education, pay and specialty. This is in no way to discredit the power of lived experience and personal knowledge of ones own illness but what are doctors good for if they know the same amount or less than what we do about our illnesses?
I have always been very bothered that doctors have not used physical medical tests to diagnose me. I feel this especially when I’m told that brain scans or spinal fluid can answer questions about my mental health. I am bothered that after only an hour appointment a person claims to have me figured out and send me a way with a diagnosis and prescription. To go off of only what I say is risky because I could lie and I have lied! Again, not to discredit personal knowledge because it is so important, and clearly all we have in this area of medicine, but mental health “medicine” seems to be so different from other areas of medicine that I am skeptical. Tests come in the form of multiple choice and a rating scale instead of blood tests, urine tests, scans etc. But maybe I am being discriminatory and saying that only the physical proof is important much like how it is easier to understand a physical disability or a mental one?
10 Reasons Survivors Might Know More Medicine Than Psychiatrists
We’ve been discussing a potential role for psychiatrists on this site, and I wanted some of the doctors to understand why many mental health escapees or graduates may know more about the mental health outcomes literature than doctors. One previous blogger pointed out that wearing a white coat and taking the Hippocratic Oath gave them some kind of expertise, but now the question is, “Who really is the expert?” Here are 10 reasons why it may not be the person with the degree and all the training.
This is an update of a post that appeared a month ago on Wellness Wordworks’ blog.
1) It’s life and death for us. That’s a pretty good motivator to learn new things.
2) Free time: Most Medical literature and medical education has been heavily influenced by the pharmacuetical industry. Most doctors have no formal exposure to mental health outcomes literature challenging the disease model of emotional suffering. My favorite blogger, 1boringoldman.com does an excellent job of explaining this. Doctors can only find truth through their own off the clock efforts, and 80 hours a week of med school and residency training doesn’t leave much off the clock time. Many mental health professionals also work a lot more than 40 hours a week, so even after their training they don’t have time. In contrary, many of us survivors have been fired repeatedly due to the labels we have been given, so we are a bit more likely to have time available.
3) Risk: Many people in recovery are often at the bottom of many pits before we start looking for new ideas. We have nothing to lose. Yet for professionals, it’s practically career suicide for them to question whether people can completely recover by exiting the mental health system and coming off medications if meds aren’t helping. Maria Bradshaw pointed out in a comment on this blog: Many doctors support struggling parent privately, but few of them are willing to risk supporting us publicly.
4) Public relations. Many people have never even heard that there might be another way to look at things, that we can improve mental health outcomes for practically free, practically overnight. We need to tell a story that we know how to help people recover, that we have a better way to do things than using labels and medications first, for everyone and forever. If we want people to leave the APA’s storytelling and tell ours, it has to be palatable. Linda Andre wrote an excellent book called, Doctors of Deception that outlined how a masterfully crafted public relations campaign has been able to show ECT as safe and effective when it’s neither.
5) Emotional toll: It’s tough to read that you’ve been harming people you wanted to help. Many more people in recovery know the true story on mental health outcomes because it’s a good news story to us, so it’s much easier to read and keep reading on our free time. It tells us we can be free again. It takes a lot of digging to come a place of intellectual honesty about deciding what is true. I read about 150 research articles, 15 books, and went to two conferences before I was sure that Whitaker was right. This is especially hard to follow through on when it means you have been hurting people your whole career. If survivors like me keep throwing up things like my 7 ECT’s, loss of grad school, loss of a chance to have kids, and loss of 10 years of my career in their face, they aren’t willing to pay that price.
6) An honorable way out: People might need a way out without admitting they have been wrong. Maybe we can figure out some way to show that life situations do intead cause our chemical changes and not just some random genetic or physical defect. This scientific explanation could satisfy the disease model advocates – simply explaining how much of our distress is due to trauma.
7) Future career plans: Many professionals don’t realize there’s a booming career in helping people get off meds or publishing medical literature about this practice.
8) The wrath of peers: Truamatized people hurt other people. This does not make hurting people right and honorable and just and excusable. Or productive. When we speak publicly in ways that scare off professionals, we get labeled with their N-word, which is the A-word in our field: antipsychiatrist. Yes, an antipsychiatrist is pretty much anyone saying anything they don’t want to hear. But, it’s also anyone who talks with emotion and anger and hurt. We need to figure out other ways to share our pain besides personal attacks on people who may or may not have caused it. This is very difficult, and I cannot always do it. Instead, I feel great respect for the advocates who snuck into the APA convention to present Max Fink with a platter of brains for his work promoting ECT.
9) Ego: To listen to survivors, you have to admit that our experience has meaning. This is contrary to the entire disease model paradigm, which says that our behavior is irrational, and not a normal response to our life situations.
10) Fear of other professionals: psychiatrists are already stigmatized compared to other medical specialties, and probably thus less likely to be able to admit they are wrong.